May 2019 Please note that all data contained within is provisional. The number of cases of measles and rubella officially reported by a member state is only available by July of each year (through the joint WHO UNICEF annual data collection exercise). If any numbers from this provisional data are quoted, they should be properly sourced with a date (i.e. "provisional data based on monthly data reported to WHO (Geneva) as of May 2019"). For official data from 1980-2017, please visit our website.

Data source for data contained within this slide deck The Global Measles and Rubella Report is based on surveillance data reported by Member States to the regional offices weekly or monthly. The regional compilation is reported to HQ monthly. Data are to be reported from the regions on the 1st Friday of the month, and HQ attempts to release the monthly report by the 3rd Monday of the month. Numbers of cases might differ from the official numbers reported annually as part of the WHO/UNICEF Joint reporting process (JRF). The difference can be due to the time lag as the annual data might not be complete at the time of reporting. In addition the difference can be due to multiple surveillance systems at country level. In these cases, the monthly data are extracted from the case based surveillance system while the annual data can be from the aggregated system. Types of data provided to WHO Epidemiologic Data: Case-based and/or Aggregate Reporting to WHO Epidemiologic data comes from Member States in one of two forms Case-based data, which is our recommendation, is provided by most member states. At WHO HQ, we collect a limited set of variables, including, age, date of onset, country reporting, 1st/2nd administrative unit of residence, vaccination status (by recall), date related to specimen collection/testing, and final classification. Regions might or might not collect more data than this. Often suspected cases with recent date of onset are not classified; however, at HQ we classify pending cases as clinically compatible and update the data if/when new data are provided to HQ. For AFR, we classify all cases that are rubella IgM positive as rubella laboratory-confirmed cases. Aggregated data on number of suspected, lab-confirmed, epi-linked, and clinically compatible cases of measles/rubella, by month/year of onset, and by subnational area (though some member states do not provide this level of disaggregation). Source for zero-reporting from some member-states though this is not a consistent process. A few member states send us both case-based and aggregated data as they have two different surveillance systems in the country. If both aggregate and case-based data are sent to HQ, numbers from aggregate surveillance are considered case counts for the country, while case-based data are used for the national slides to show age distribution, proportion vaccinated, and age-specific incidence. Limitations Reporting delays: It can take 2-3 months from the time a case is reported to public health in a member state to the time the data are provided to WHO HQ. Some of this is due to normal reporting delays that are expected as it takes time to get information from a health center to Geneva based on reporting frequencies set by various levels We are working to decrease the delays in reporting. Underreporting/lack of reporting Case definitions for suspect, epidemiologically linked and clinically compatible cases may vary between countries. Completeness of the data reported to WHO is unknown For this monthly update, pending cases are considered measles clinically compatible. These cases may later be discarded or confirmed based on laboratory testing in which case historical case counts may vary from one report to another. This could lead to differences between the Global monthly report and Regional or National surveillance bulletins published by WHO Offices and National authorities. ELISA Laboratory Data from the Global Measles and Rubella Laboratory Network (GMRLN) The Global Measles Rubella Laboratory Network laboratories report the number of samples received as well as the number of samples tested for IgM serology, as well as the number positive, negative and equivocal. These aggregated data are collected to account for the inadequate linking between laboratory and epidemiological data in some countries. Numbers of cases reported may differ from the number of samples tested positive for various reasons Samples tested positive in a laboratory may not reported to the surveillance system IgG screening results are inappropriately included in the surveillance database Inconsistent reporting from laboratories. This is based on the number of SAMPLES tested, not the number of CASES tested. One case can have multiple samples being tested (e.g. different specimen types, repeat specimen collection based on timing of collection). Data are only from network laboratories Non-network laboratories are not included Some laboratories don’t report IgG results are sometimes inappropriately reported Genotyping Data Genotyping data are obtained from the MeaNS (www.who-measles.org) and RubeNS (www.who-rubella.org). Inadequate sample collection for genotyping challenges interpretation of the data Underreporting WHO recommends that Member States submit genotyping data to these databases, but it is not currently a requirement so there is underreporting Genotype data can’t be linked to epidemiologic data at the global level

Measles

Number of Reported Measles Cases by WHO Regions 2019 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 41/47 90128 83398 10207 69762 3429 43022 27313 11105 1958 2019-05 AMR 29/35 4949 1080 109 239 252 480 EMR 19/21 11124 7319 4557 526 2236 2959 3477 871 12 EUR 53/53 53839 51279 33091 3098 15090 18866 17651 14718 44 SEAR 11/11 27259 19726 13136 2836 3754 5658 6979 6574 515 WPR 26/27 20642 5391 3496 23 1872 2770 1323 1286 Total 179/194 207941 168193 64487 76245 27461 73384 56982 34806 3021 2018 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 81844 55430 14267 33612 7551 2945 4325 5071 3887 2947 1774 1715 1296 1882 5135 9981 14472 2019-05 AMR 32/35 29610 16689 3 16 84 152 291 204 410 139 645 2609 5952 6184 EMR 20/21 80732 58056 29825 16271 11960 4009 4863 8067 7975 9647 5649 4486 2765 3031 3065 2395 2104 EUR 53/53 97445 84089 50973 4239 28877 5964 7143 7419 7735 8719 7127 5411 3704 2736 5453 9939 12739 SEAR 11/11 107058 83907 57433 19210 7264 9006 9156 14301 12217 10946 5041 3489 3847 3274 4517 3780 4333 WPR 26/27 75231 30389 18294 1742 10353 1926 2479 3389 3229 3051 2422 2221 1949 1923 2610 3043 2147 Total 184/194 471920 328560 170792 75074 82694 23853 27982 38331 35195 35601 22217 17732 13700 13491 23389 35090 41979 Notes: Based on data received 2019-05 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Number of Reported Measles Cases by WHO Regions 2019 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 41/47 90128 83398 10207 69762 3429 43022 27313 11105 1958 2019-05 AMR 29/35 4949 1080 109 239 252 480 EMR 19/21 11124 7319 4557 526 2236 2959 3477 871 12 EUR 53/53 53839 51279 33091 3098 15090 18866 17651 14718 44 SEAR 11/11 27259 19726 13136 2836 3754 5658 6979 6574 515 WPR 26/27 20642 5391 3496 23 1872 2770 1323 1286 Total 179/194 207941 168193 64487 76245 27461 73384 56982 34806 3021 2018 Region Member States* Suspected cases Measles cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 41/47 17091 11577 7783 2264 1530 3123 3658 3973 823 2018-05 AMR 28/35 3368 484 3 10 68 403 EMR 19/21 7069 3351 798 195 2358 1890 651 12 EUR 50/53 19846 18380 10172 723 7485 5549 6287 6482 62 SEAR 10/11 12749 9838 7970 1006 862 5374 3515 784 165 WPR 26/27 14254 7435 4936 100 2399 1918 2444 2835 238 Total 174/194 74377 51065 31659 4288 15118 17857 16712 14793 1703 Notes: Based on data received 2019-05 and 2018-05 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Measles case distribution by month and WHO Region (2015-2019) 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 5000 10000 15000 20000 25000 30000 35000 40000 45000 50000 55000 60000 65000 70000 75000 80000 Month of onset Measles cases (Lab+Epi+Clinical) AFR AMR EMR EUR SEAR WPR Notes: Based on data received 2019-05 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete. 2019-05-08

(12M period) Top 10** Country Cases Rate Madagascar 84804 3406.53 Ukraine 78659 1770.06 India**** 53170 40.15 Pakistan 22693 117.46 Philippines 16898 163.55 Yemen 13639 494.45 Nigeria 12745 68.53 Brazil 10316 49.68 Thailand 6914 100.4 Kazakhstan 5908 328.45 Other countries with high incidence rates*** Country Cases Rate Georgia 4678 1191.72 Liberia 2367 513.02 Israel 3755 458.38 Kyrgyzstan 2534 425.47 The Republic of North Macedonia 885 425.23 Albania 1169 399.47 Measles cases from countries with known discrepancies between case-based and aggregate surveillance, as reported by country Country Year Cases in Case-based Cases in Aggregate Data Source for aggregate #s DR Congo 2018 5621 67072 SITUATION EPIDEMIOLOGIQUE DE LA ROUGEOLE EN RDC, Week of 07/05/2019 2019 1414 76107 Somalia 131 9135 Somali EPI/POL Weekly Update Week 17 6 1432 Notes: Based on data received 2019-05 and covering the period between 2018-04 and 2019-03 - Incidence: Number of cases / population* * 100,000 - * World population prospects, 2017 revision - ** Countries with the highest number of cases for the period - *** Countries with the highest incidence rates (excluding those already listed in the table above) ****WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports.

(6M period) Top 10* Country Cases Madagascar 84765 Ukraine 56094 India** 19544 Nigeria 10610 Brazil 8663 Philippines 7518 Yemen 6779 Kazakhstan 5902 Thailand 5784 Venezuela (Bolivarian Republic of) 5668 Notes: Based on data received 2019-05 - Surveillance data from 2018-10 to 2019-03 - * Countries with highest number of cases for the period **WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports.

Disclaimer *UN population data is used as the denominator for calculating incidence.

Measles case distribution (AFR), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 22000 24000 26000 28000 30000 32000 34000 36000 38000 40000 42000 44000 46000 Month of onset Number of measles cases Uganda Others Nigeria Niger Madagascar Liberia Ethiopia Equatorial Guinea DR Congo Chad Cameroon DRC has experienced a nationwide epidemic that has affected all Provinces, however, only a small proportion of the measles cases in the IDSR aggregate reporting system are reflected in the case based data. As of 27 May 2013, South Sudan has reassigned to the Africa region (AFR) from the Eastern Mediterranean region (EMR). For data presentation and statistical purposes, South Sudan data is presented in AFR for all the years. 2019-05-08

Measles cases: Angola Number of cases Month of onset 100 200 300 400 500 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases National (6 M-14 Y) Cov: 93% National SIA Sub-national SIA 50 100 150 200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Angola age distribution, vaccination status, and incidence, 2018-04 to 2019-03 20 40 Incidence rate per 1,000,000 29.3 44.4 24.1 8.3 6.2 2 0.8 Year Confirmed Cases 2006 825 2007 245 2008 120 2009 2441 2010 1390 2011 192 2012 4470 2013 6564 2014 12002 2015 194 2016 51 2017 29 2018 57 2019 759

Measles cases: Cameroon 100 200 300 400 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9-59 M) Cov: 88% National SIA Sub-national SIA 200 400 600 800 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Cameroon age distribution, vaccination status, and incidence, 2018-04 to 2019-03 50 100 150 250 Incidence rate per 1,000,000 222 239 74.7 21.4 7.4 4.2 1.5 Year Confirmed Cases 2006 192 2007 96 2008 494 2009 870 2010 228 2011 909 2012 616 2013 774 2014 765 2015 1999 2016 694 2017 712 2018 896 2019 822

Measles cases: Chad Number of cases Month of onset 200 400 600 800 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-9 Y) Cov: 100% National SIA Sub-national SIA 200 400 600 800 1000 1200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Chad age distribution, vaccination status, and incidence, 2018-04 to 2019-03 100 300 500 Incidence rate per 1,000,000 527.3 520 219.1 129.2 89.8 64.8 13.4 Year Confirmed Cases 2006 15 2007 65 2008 70 2009 632 2010 219 2011 156 2012 153 2013 217 2014 1251 2015 477 2016 169 2017 30 2018 1079 2019 1484

Measles cases: Democratic Republic of the Congo 500 1000 1500 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Due to surveillance gaps, case-based data is a poor representation of the current situation in DRC 1000 2000 3000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Democratic Republic of the Congo age distribution, vaccination status, and incidence, 2018-04 to 2019-03 50 100 150 200 250 Incidence rate per 1,000,000 227.8 222.8 78.7 15.6 7.4 4.5 0.8 Year Confirmed Cases 2006 1012 2007 539 2008 214 2009 83 2010 208 2011 1651 2012 2332 2013 2527 2014 1649 2015 6110 2016 5463 2017 3610 2018 5606 2019 1991

Measles cases: Ethiopia 100 200 300 400 500 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-179 M) Cov: 98% National SIA Sub-national SIA Cases are occurring but data has not been reported to WHO. > 4000 cases since Oct 2018 50 100 150 200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Ethiopia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 10 20 Incidence rate per 1,000,000 19.1 17 8.5 5.4 9 6.8 1 Year Confirmed Cases 2006 1278 2007 1472 2008 3161 2009 2642 2010 6205 2011 3552 2012 4616 2013 6137 2014 14282 2015 20660 2016 4577 2017 1921 2018 1351

Measles cases: Madagascar 10000 20000 30000 40000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-14 Y) Cov: 94% National SIA Sub-national SIA 5000 10000 15000 20000 25000 30000 35000 40000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Madagascar age distribution, vaccination status, and incidence, 2018-04 to 2019-03 1000 2000 3000 4000 6000 7000 8000 9000 11000 12000 13000 14000 16000 17000 18000 19000 21000 22000 23000 24000 26000 27000 28000 29000 31000 32000 33000 34000 36000 37000 38000 39000 41000 42000 43000 44000 45000 46000 47000 48000 49000 50000 51000 52000 53000 Incidence rate per 1,000,000 44741.4 3119.4 2496.4 2185.5 1144.3 595.9 843 Year Confirmed Cases 2006 2 2007 2008 12 2009 2010 1 2011 2012 3 2013 7 2014 2015 10 2016 20 2017 85 2018 23558 2019 61401

Measles cases: Nigeria 2000 4000 6000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases National (9-59 M) Cov: 107% Cov: 106% National SIA Sub-national SIA 2000 4000 6000 8000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Nigeria age distribution, vaccination status, and incidence, 2018-04 to 2019-03 100 200 300 Incidence rate per 1,000,000 286 301.5 93.7 27.8 6.5 2.9 0.8 Year Confirmed Cases 2006 1019 2007 3129 2008 10453 2009 1498 2010 9072 2011 19062 2012 6423 2013 55392 2014 6850 2015 15656 2016 16438 2017 11196 2018 7018 2019 10626

Measles case distribution (AMR), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 Month of onset Number of measles cases Venezuela (Bolivarian Republic of) USA Peru Others Mexico Costa Rica Colombia Chile Canada Brazil Argentina Notes: Based on data received 2019-05 - Data Source: IVB Database 2019-05-08

Measles cases: United States of America 100 200 300 400 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Year Confirmed Cases 2008 140 2009 71 2010 63 2012 55 2013 188 2014 668 2015 208 2016 80 2017 120 2018 372 2019 704

Measles case distribution (EMR), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 7000 7500 8000 8500 9000 9500 10000 10500 Month of onset Number of measles cases Yemen United Arab Emirates Syrian Arab Republic Sudan Saudi Arabia Pakistan Others Lebanon Iraq Egypt Afghanistan Notes: Based on data received 2019-05 - Data Source: IVB Database 2019-05-08

Measles cases: Pakistan 2000 4000 6000 8000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 5000 10000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Pakistan age distribution, vaccination status, and incidence, 2018-04 to 2019-03 200 400 600 800 1000 1200 Incidence rate per 1,000,000 1119.3 604.9 180.7 34.1 4.6 1.7 0.3 Year Confirmed Cases 2006 35 2007 33 2008 53 2009 472 2010 1111 2011 2676 2012 8048 2013 8030 2014 1370 2015 1117 2016 2806 2017 6780 2018 33248 2019 454

Measles cases: Saudi Arabia 200 400 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 100 200 300 400 500 600 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Saudi Arabia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 800 Incidence rate per 1,000,000 775.1 203.4 52.6 9.4 8.1 10.6 3.4 Year Confirmed Cases 2006 813 2007 3550 2008 318 2009 80 2010 403 2011 561 2012 281 2013 253 2014 153 2015 297 2016 106 2017 429 2018 1029 2019 654

Measles cases: Sudan Number of cases Month of onset 200 400 600 800 1000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 1000 2000 3000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Sudan age distribution, vaccination status, and incidence, 2018-04 to 2019-03 200 400 600 800 Incidence rate per 1,000,000 880 521.1 170.3 54.9 63.4 55.3 7.8 Year Confirmed Cases 2006 274 2007 483 2008 97 2009 68 2010 613 2011 5616 2012 8521 2013 2811 2014 676 2015 3585 2016 1767 2017 665 2018 4978 2019 1257

Measles cases: Tunisia 100 200 300 400 500 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 100 200 300 400 500 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Tunisia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 1000 1500 2000 2500 Incidence rate per 1,000,000 2362.4 160.7 2.3 1.4 0.7 Year Confirmed Cases 2006 2007 5 2008 2009 2 2010 2011 14 2012 48 2013 17 2014 16 2015 19 2016 7 2017 2018 12 2019 625

Measles cases: Yemen Number of cases Month of onset 1000 2000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 2000 4000 6000 8000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Yemen age distribution, vaccination status, and incidence, 2018-04 to 2019-03 1000 3000 Incidence rate per 1,000,000 2654.8 2176.3 905.4 208.1 61.1 59.8 10.6 Year Confirmed Cases 2006 4989 2007 50 2008 53 2009 127 2010 372 2011 847 2012 2143 2013 571 2014 817 2015 465 2016 143 2017 2101 2018 13622 2019 3470

Measles case distribution (EUR), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 11000 12000 13000 14000 15000 16000 17000 18000 19000 20000 Month of onset Number of measles cases Ukraine Serbia Russian Federation Romania Others Kyrgyzstan Kazakhstan Italy Germany Georgia France Notes: Based on data received 2019-05 - Data Source: IVB Database 2019-05-08

Measles cases: Bosnia and Herzegovina 100 200 300 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 50 100 150 200 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Bosnia and Herzegovina age distribution, vaccination status, and incidence, 2018-04 to 2019-03 500 1000 1500 Incidence rate per 1,000,000 1169.7 1300.8 289.9 48.2 33.5 26.8 37.2 Year Confirmed Cases 2006 2009 8 2010 2011 5 2013 2014 2204 2015 2238 2016 45 2017 27 2018 89 2019 327

Measles cases: Bulgaria 100 200 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 20 40 60 80 100 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Bulgaria age distribution, vaccination status, and incidence, 2018-04 to 2019-03 200 400 600 800 Incidence rate per 1,000,000 701.4 318.5 156.7 18.9 30.3 15.3 1.8 Year Confirmed Cases 2006 1 2007 2008 2009 2249 2010 22006 2011 155 2012 2013 14 2014 2015 2016 2017 165 2018 13 2019 236

Measles cases: Georgia 200 400 600 800 1000 1200 1400 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 500 1000 1500 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Georgia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 2000 3000 4000 5000 6000 7000 8000 9000 10000 Incidence rate per 1,000,000 8945.3 3052.7 1168.4 1528.1 1704.5 1756 241.9 Year Confirmed Cases 2006 8 2007 2 2008 55 2009 23 2010 22 2011 64 2012 30 2013 7868 2014 3190 2015 430 2016 14 2017 96 2018 2203 2019 2917

Measles cases: Israel Number of cases Month of onset 200 400 600 800 1000 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 1200 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Israel age distribution, vaccination status, and incidence, 2018-04 to 2019-03 2000 3000 4000 Incidence rate per 1,000,000 4040.1 1529.6 868.3 470.2 341.4 210.8 117.1 Year Confirmed Cases 2006 8 2007 539 2008 891 2009 5 2010 19 2011 46 2012 149 2013 57 2014 3 2015 80 2016 10 2017 16 2018 3154 2019 614

Measles cases: Kazakhstan 1000 2000 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 500 1000 1500 2000 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Kazakhstan age distribution, vaccination status, and incidence, 2018-04 to 2019-03 3000 4000 5000 6000 Incidence rate per 1,000,000 5252 1223.7 195.8 113.9 51.1 181.1 111.6 Year Confirmed Cases 2006 87 2007 6 2008 24 2009 2011 30 2012 109 2013 73 2014 317 2015 2340 2016 110 2017 2 2018 576 2019 5332

Measles cases: Kyrgyzstan 200 400 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 200 400 600 800 1000 1200 1400 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Kyrgyzstan age distribution, vaccination status, and incidence, 2018-04 to 2019-03 2000 3000 4000 5000 6000 7000 8000 9000 Incidence rate per 1,000,000 7554 1448.2 189.4 70.4 160.6 77 31.3 Year Confirmed Cases 2006 26 2007 2 2008 16 2009 2010 1 2011 210 2012 2013 2014 318 2015 17779 2016 2017 5 2018 1104 2019 1512

Measles cases: Lithuania 100 200 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 50 100 150 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Lithuania age distribution, vaccination status, and incidence, 2018-04 to 2019-03 200 300 Incidence rate per 1,000,000 234.9 311.2 112.5 75.5 122.9 243.8 75.4 Year Confirmed Cases 2006 1 2007 2008 2009 2010 2 2011 7 2012 2013 35 2014 11 2015 51 2016 22 2017 2018 33 2019 329

Measles cases: The Republic of North Macedonia 100 200 300 400 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 100 200 300 400 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases The Republic of North Macedonia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 1000 2000 3000 4000 5000 6000 7000 Incidence rate per 1,000,000 6645.4 1757.7 356.6 152.2 69.6 247 387.1 Year Confirmed Cases 2006 2007 2008 28 2009 3 2010 209 2011 731 2012 6 2013 4 2014 107 2015 1 2016 2017 20 2018 64 2019 829

Measles cases: Russian Federation 200 400 600 800 1000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 100 200 300 400 500 600 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Russian Federation age distribution, vaccination status, and incidence, 2018-04 to 2019-03 20 40 60 80 Incidence rate per 1,000,000 79.6 74.5 39.8 26.7 19.8 15.7 5.4 Year Confirmed Cases 2006 1129 2007 172 2008 27 2009 101 2010 152 2011 783 2012 1975 2013 2501 2014 3263 2015 635 2016 179 2017 897 2018 2256 2019 1091

Measles cases: Ukraine 5000 10000 15000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 5000 10000 15000 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Ukraine age distribution, vaccination status, and incidence, 2018-04 to 2019-03 1000 2000 3000 4000 6000 7000 8000 9000 Incidence rate per 1,000,000 7808.5 5530 6306.7 6023.7 1859.8 1245 684.6 Year Confirmed Cases 2006 945 2007 232 2008 41 2009 24 2010 42 2011 1313 2012 12744 2013 3308 2014 2326 2015 141 2016 90 2017 4782 2018 53218 2019 34188

Measles case distribution (SEAR (excl. India)), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 500 1000 1500 2000 2500 3000 3500 Month of onset Number of measles cases Timor-Leste Thailand Sri Lanka Nepal Myanmar Maldives Indonesia DPR Korea Bhutan Bangladesh Notes: Based on data received 2019-05 - Data Source: IVB Database 2019-05-08

Measles cases: Indonesia 1000 2000 3000 4000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (9 M-15 Y) Cov: 101% Cov: 73% National SIA Sub-national SIA 50 100 150 200 250 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Indonesia age distribution, vaccination status, and incidence, 2018-04 to 2019-03 5 10 15 Incidence rate per 1,000,000 15.9 9 10.2 3.6 2.3 0.5 Year Confirmed Cases 2006 21911 2007 20837 2008 16417 2009 21008 2010 23471 2011 23510 2012 16786 2013 10093 2014 9498 2015 6209 2016 7204 2017 11389 2018 5427 2019 458

Measles cases: Myanmar 500 1000 1500 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 500 1000 1500 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Myanmar age distribution, vaccination status, and incidence, 2018-04 to 2019-03 100 200 300 400 Incidence rate per 1,000,000 441.5 358.7 186.8 63.3 88.5 38.1 2.1 Year Confirmed Cases 2006 760 2007 1087 2008 334 2009 501 2010 432 2011 1810 2012 2164 2013 1000 2014 110 2015 6 2016 274 2017 1246 2018 1391 2019 3424

Measles cases: Thailand 1000 2000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases 500 1000 1500 2000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Thailand age distribution, vaccination status, and incidence, 2018-04 to 2019-03 Incidence rate per 1,000,000 1698.1 631.4 217.8 110 123.9 75.9 4.8 Year Confirmed Cases 2006 3962 2007 3517 2008 6339 2009 5272 2010 2273 2011 2873 2012 4072 2013 2056 2014 834 2015 190 2016 1009 2017 2033 2018 5160 2019 2319

Measles case distribution (SEAR, India*), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 5000 10000 15000 Month of onset Number of measles cases India Notes: Based on data received 2019-05 - Data Source: IVB Database. *WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports. 2019-05-08

Measles cases: India* Number of cases Month of onset 10000 20000 30000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases National SIA Sub-national SIA 2000 4000 6000 8000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases India age distribution, vaccination status, and incidence, 2018-04 to 2019-03 20 40 60 80 100 Incidence rate per 1,000,000 85.1 69.9 44.2 12.4 4.6 1.5 0.1 Year Confirmed Cases 2014 80306 2015 83026 2016 70798 2017 61288 2018 69391 2019 12439 *WHO classifies all suspected measles cases reported from India as measles clinically compatible if a specimen was not collected as per the algorithm for classification of suspected measles in the WHO VPD Surveillance Standards. Thus numbers might be different between what WHO reports and what India reports. Additionally, data on this slide comes from two different surveillance systems within India and therefore there will be discrepancies between the epi-curve and the bottom graph.

Measles case distribution (WPR), 2015-2019 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2000 4000 6000 8000 10000 12000 14000 16000 18000 Month of onset Number of measles cases Viet Nam Singapore Republic of Korea Philippines Others New Zealand Mongolia Malaysia Japan China Australia Notes: Based on data received 2019-05 - Data Source: IVB Database 2019-05-08

Measles cases: Philippines 1000 2000 3000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Discarded Clinical Epi Lab Month of onset Number of cases Sub-national (6-59 M) Cov: 69% Cov: 32% National SIA Sub-national SIA 2000 4000 6000 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years 0 doses 1 dose 2+ doses Unknown Age at onset Number of cases Philippines age distribution, vaccination status, and incidence, 2018-04 to 2019-03 500 1000 1500 2500 Incidence rate per 1,000,000 2318.9 669.5 110 54.8 106 58.7 7.1 Year Confirmed Cases 2006 216 2007 612 2008 838 2009 1351 2010 6363 2011 6519 2012 1441 2013 4855 2014 53906 2015 2021 2016 647 2017 2409 2018 20758 2019 1802

(last 12 months) Notes: Data Source: MeaNS database (Genotypes) and IVB Database (Incidence) as of 2019-05-08 and covering the period 2018-04-01 to 2019-03-31 - Pie charts proportional to the number of sequenced viruses

Rubella

Number of Reported Rubella Cases by WHO Regions 2019 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 34/47 1034 201 243 453 137 2019-05 AMR 24/35 EMR 17/21 103 1 102 49 43 10 EUR 28/53 213 171 2 40 74 73 66 SEAR 11/11 778 166 255 341 16 WPR 13/27 5606 533 163 4910 1135 1264 3207 Total 127/194 7734 705 165 6864 1625 1878 4077 154 2018 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 42/47 3388 345 368 571 373 353 261 223 226 177 203 175 113 2019-05 AMR 27/35 2 1 EMR 20/21 1492 149 313 1030 172 232 199 202 115 108 83 71 81 46 34 EUR 36/53 847 736 7 104 82 96 75 90 80 61 73 50 42 49 53 SEAR 11/11 4280 1307 2973 328 481 840 929 526 194 130 188 206 145 WPR 14/27 3610 65 3322 105 95 277 494 760 341 265 222 290 344 391 26 Total 150/194 13619 1108 1692 10819 1009 1213 1995 2092 1931 991 787 792 811 876 806 316 Notes: Based on data received 2019-05 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Number of Reported Rubella Cases by WHO Regions 2019 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 34/47 1034 201 243 453 137 2019-05 AMR 24/35 EMR 17/21 103 1 102 49 43 10 EUR 28/53 213 171 2 40 74 73 66 SEAR 11/11 778 166 255 341 16 WPR 13/27 5606 533 163 4910 1135 1264 3207 Total 127/194 7734 705 165 6864 1625 1878 4077 154 2018 Region Member States* Rubella cases Clin Epi Lab Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Received AFR 37/47 902 246 202 322 132 2018-05 AMR 21/35 EMR 18/21 229 2 227 64 87 78 EUR 25/53 164 138 1 25 52 54 58 SEAR 10/11 560 558 197 127 7 WPR 14/27 421 57 357 107 97 217 Total 125/194 2276 10 2069 666 669 802 139 Notes: Based on data received 2019-05 and 2018-05 - This is surveillance data, hence for the last month, the data may be incomplete. * Member States Reporting / Total Member States in Region

Rubella Case Distribution by Month and WHO Region (2015-2019) 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2016-01 2016-02 2016-03 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 Month of onset Rubella cases (Lab+Epi+Clinical) WPR SEAR EUR EMR AMR AFR Notes: Based on data received 2019-05 - Data Source: IVB Database - This is surveillance data, hence for the last month(s), the data may be incomplete. 2019-05-08

Other countries with high incidence rates*** (12M period) Top 10** Country Cases Rate China 7226 5.150 India 1757 1.330 Indonesia 1227 4.700 Japan 1198 9.380 Nigeria 845 4.540 Poland 437 11.430 Ethiopia 415 4.050 Uganda 389 Pakistan 386 2.000 South Africa 356 6.360 Other countries with high incidence rates*** Country Cases Rate Congo 103 20.090 Central African Republic 76 16.540 Yemen 308 11.170 Liberia 44 9.540 Malaysia 175 5.610 Notes: Based on data received 2019-05 and covering the period between 2018-04 and 2019-03 - Incidence: Number of cases / population* * 100,000 - * World population prospects, 2017 revision - ** Countries with the highest number of cases for the period - *** Countries with the highest incidence rates (excluding those already listed in the table above)

Rubella cases: AFR 600 500 400 300 200 100 500 400 Number of cases 100 200 300 400 500 600 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (IgM+ only) AFR Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Nigeria No 788 28 Uganda 390 14 DR Congo 330 12 South Africa 319 Ethiopia 297 11 Others - 265 10 Central African Republic 96 3 Congo Mozambique 2018 95 Cote d'Ivoire 45 2 Liberia 44 100 200 300 400 500 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (IgM+ only) AFR Age distribution of Rubella IgM+ cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 2019-05-08

Rubella cases: EMR 200 100 200 (lab + epi-linked + clinical) 100 200 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) EMR Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Pakistan No 287 34 Yemen 2015 282 33 Sudan 116 14 Saudi Arabia 1991 38 5 Tunisia 2004 28 3 Afghanistan 2018 27 United Arab Emirates 1985 20 2 Others - 16 Libya 1995 13 Morocco 2014 10 1 Egypt 1999 6 100 200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) EMR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 2019-05-08

Rubella cases: EUR 100 80 60 40 20 200 (lab + epi-linked + clinical) 20 40 60 80 100 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) EUR Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Poland 1988 390 55 Ukraine 2001 183 26 Germany 1991 49 7 Russian Federation 2000 17 2 Italy 1972 16 Others - 15 Spain 1978 Turkey 2006 11 Romania 2002 6 1 Portugal 1984 5 Georgia 2004 4 100 200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) EUR Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. Spikes in age-distribution curve are an artifact of reporting by age bands ( 0=<1 yrs, 2=1-4 yrs, 7=5-9 yrs, 12=10-14 yrs, 17=15-19 yrs, 25=20-29 yrs, 45=30+yrs) instead of by age from some member states. 2019-05-08

Rubella cases: Ukraine 20 40 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Clinical Epi Lab Number of cases SIA (6-9 Y) Cov: 67% SIA (1-9 Y) Cov: 57% National SIA Sub-national SIA Year Confirmed Cases 2015 2016 2017 2018 235 2019 63 20 40 60 80 100 120 <1 year 1-4 years 5-9 years 10-14 years 15-19 years 20-29 years 30+ years Male Female Unknown Age at onset Number of cases Ukraine age distribution, sex, and incidence, 2018-04 to 2019-03 5 10 15 25 30 Incidence rate per 1,000,000 12.1 15.9 6.5 4.1 1.2 4.2

Rubella cases: SEAR (excl. India) 200 400 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) SEAR (excl. India) Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total Indonesia No 1027 75 Bangladesh 2012 206 15 Thailand 1993 91 7 Nepal 2013 34 2 Myanmar 2015 13 1 Timor-Leste 2016 100 200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) SEAR (excl. India) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 2019-05-08

Rubella cases: SEAR, India 200 400 600 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) SEAR, India Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total India No 1107 100 100 200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) SEAR, India Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 2019-05-08

Rubella cases: Thailand 10 20 30 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Clinical Epi Lab Number of cases Year Confirmed Cases 2015 36 2016 7 2017 24 2018 54 2019 46 5 10 15 20 25 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Male Female Unknown Age at onset Number of cases Thailand age distribution, sex, and incidence, 2018-04 to 2019-03 30 Incidence rate per 1,000,000 28.3 3.6 0.5 1 2.3 1.5 0.4

Rubella cases: WPR 3000 2000 1000 400 (lab + epi-linked + clinical) 1000 2000 3000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Not introduced in EPI Introduced <5 years ago (after 2013) Introduced >=5 years ago (2013 and before) Month of onset Number of cases (lab + epi-linked + clinical) WPR Rubella Case Distribution (May 2017-April 2019) Top 10 countries (last 12 M) label RCV in RI Cases % of Total China 2008 6775 82 Japan 1989 1197 15 Malaysia 1998 155 2 Philippines 2010 52 1 Viet Nam 2015 29 Singapore 1990 13 Cambodia 2013 12 Lao People's Democratic Republic 2012 10 Mongolia 2009 Republic of Korea 1982 100 200 300 400 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Rubella vaccine not introduced before 1 January 2017 Rubella vaccine introduced before 1 January 2017 Age at onset (in years) Number of cases (lab + epi-linked + clinical) WPR (Excl. China) Age distribution of Rubella cases by vaccine introduction status in the National EPI Programme (May 2018-April 2019) Notes: Based on data received 2019-05 Data Source: IVB Database. RCV in RI: Rubella-containing vaccine in Routine Immunization as of 31 Dec 2016. 2019-05-08

Rubella cases: China 3000 Number of cases 2000 1000 Confirmed Cases 1000 2000 3000 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Clinical Epi Lab Number of cases Year Confirmed Cases 2014 11887 2015 8247 2016 4477 2017 1601 2018 3158 2019 4434

Rubella cases: Japan 500 Number of cases 400 300 200 100 600 100 200 300 400 500 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 2018-07 2018-08 2018-09 2018-10 2018-11 2018-12 2019-01 2019-02 2019-03 2019-04 2019-05 Clinical Epi Lab Number of cases The data from Japan is under-reported to WHO; the case counts for Japan can be found here. As of week 16, there are 1331 rubella cases in Japan. Year Confirmed Cases 2014 2015 2 2016 3 2017 5 2018 68 2019 1130 100 200 300 400 500 600 <1 year 1-4 years 5-9 years 10-14 years 15-24 years 25-39 years 40+ years Male Female Unknown Age at onset Number of cases Japan age distribution, sex, and incidence, 2018-04 to 2019-03 5 10 15 20 Incidence rate per 1,000,000 2.9 1.6 0.9 1.8 12.8 20.6 7.3

(last 12 months) Notes: Data Source: RubNS database (Genotypes) and IVB Database (Incidence) as of 2019-05-08 and covering the period 2018-04-01 to 2019-03-31 - Pie charts proportional to the number of sequenced viruses

Laboratory

Measles and Rubella IgM Data Summary 2019 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 36/47 11235 3924 (35) 330 (3) 6981 (62) 7048 1072 (15) 352 (5) 5624 (80) AMR 25/35 4142 3561 203 (6) 58 (2) 3130 (88) 3460 232 (7) 148 (4) 2936 (85) EMR 19/21 8556 6180 2324 (38) 32 (1) 3824 (62) 5312 143 (3) 28 (1) 5141 (97) EUR 36/53 47673 43319 20600 (48) 387 (1) 21751 (50) 22530 731 (3) 85 (0) 21692 (96) SEAR 11/11 13122 11487 4797 (42) 206 (2) 6504 (57) 7064 654 (9) 162 (2) 6225 (88) WPR 27/27 17774 16680 3461 (21) 176 (1) 5083 (30) 13074 694 (5) 106 (1) 4178 (32) Total 154/194 102502 92462 35309 (38) 1189 (1) 47273 (51) 58488 3526 (6) 881 (2) 45796 (78) 2018 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 41/47 48221 10088 (21) 1252 (3) 36881 (76) 37144 5006 (13) 2066 (6) 30072 (81) AMR 30/35 19110 18753 1551 (8) 203 (1) 16548 (88) 16018 554 (3) 432 (3) 14620 (91) EMR 20/21 60673 36544 12960 (35) 168 (0) 23416 (64) 33310 1725 (5) 361 (1) 31224 (94) EUR 38/53 120470 109966 36776 (33) 644 (1) 71986 (65) 71582 1382 (2) 248 (0) 69904 (98) SEAR 11/11 34075 31209 11945 (38) 790 (3) 18454 (59) 20872 2561 (12) 519 (2) 17792 (85) WPR 27/27 34896 30327 5630 (19) 570 (2) 14368 (47) 24972 646 (3) 456 (2) 12961 (52) Total 167/194 317445 275020 78950 (29) 3627 (1) 181653 (66) 203898 11874 (6) 4082 (2) 176573 (87) Notes: Based on data received 2019-05 - * Member States Reporting / Total Member States in Region

Measles and Rubella IgM Data Summary Data as of May 2019 2019 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 36/47 11235 3924 (35) 330 (3) 6981 (62) 7048 1072 (15) 352 (5) 5624 (80) AMR 25/35 4142 3561 203 (6) 58 (2) 3130 (88) 3460 232 (7) 148 (4) 2936 (85) EMR 19/21 8556 6180 2324 (38) 32 (1) 3824 (62) 5312 143 (3) 28 (1) 5141 (97) EUR 36/53 47673 43319 20600 (48) 387 (1) 21751 (50) 22530 731 (3) 85 (0) 21692 (96) SEAR 11/11 13122 11487 4797 (42) 206 (2) 6504 (57) 7064 654 (9) 162 (2) 6225 (88) WPR 27/27 17774 16680 3461 (21) 176 (1) 5083 (30) 13074 694 (5) 106 (1) 4178 (32) Total 154/194 102502 92462 35309 (38) 1189 (1) 47273 (51) 58488 3526 (6) 881 (2) 45796 (78) Data as of May 2018 2018 Region Member States* Specimens received Measles tested Measles positive n(%) Measles equivocal n(%) Measles negative n(%) Rubella tested Rubella positive n(%) Rubella equivocal n(%) Rubella negative n(%) AFR 32/47 5772 940 (16) 143 (2) 4689 (81) 4550 786 (17) 295 (6) 3469 (76) AMR 26/35 3784 3599 140 (4) 25 (1) 3075 (85) 3365 134 (4) 66 (2) 2831 (84) EMR 19/21 6999 6413 2522 (39) 11 (0) 3880 (61) 5027 262 (5) 22 (0) 4743 (94) EUR 35/53 14454 14102 4673 (33) 94 (1) 9218 (65) 6957 169 (2) 15 (0) 6754 (97) SEAR 11/11 6880 5687 2289 (40) 174 (3) 3220 (57) 3570 620 (17) 119 (3) 2827 (79) WPR 27/27 6060 5761 1114 (19) 122 (2) 2958 (51) 4486 113 (3) 80 (2) 1995 (44) Total 150/194 43949 41334 11678 (28) 569 (1) 27040 (65) 27955 2084 (7) 597 (2) 22619 (81) Notes: Based on data received 2019-05 and 2018-05 - * Member States Reporting / Total Member States in Region

Performance of Surveillance

Surveillance sensitivity reporting rate of measles and rubella (12 months, discarded cases* per 100,000 population) Notes: Based on data received 2019-05 and covering the period between 2018-04 and 2019-03 - Target: >= 2 discarded cases* / 100,000 population** - * Suspected cases investigated and discarded as non- measles non-rubella using laboratory testing and/or epidemiological linkage to another etiology ** World population prospects, 2017 revision

Supplementary Immunization Activities

Next 6 months MMR, MR and Measles campaigns Region Name Activity Type Year StartDate EndDate Age Group(s) Extent Target AFR Kenya FollowUp MR 2019 2019-06-01 - 9-59 M National 7253043 WPR Papua New Guinea 6-59 M 1173092 Sierra Leone CatchUp 2019-06-10 2019-06-16 9 M-14 Y 3091220 SEAR India 2019-07-01 9 M-15 Y Rollover-Nat 27779000 2019-08-01 180000 Cameroon 2019-09-01 3275427 Democratic Republic of the Congo (the) Measles Sub-national 11013139 Nigeria 2019-12-31 22246688 Uganda 9 M->15 Y 16693933 United Republic of Tanzania 7076108 Zimbabwe 1780643 Solomon Islands 1-4 Y 68173 Madagascar 2019-10-01 4039764 South Sudan 2540115 Bangladesh 15686575 Democratic People's Republic of Korea (the) 6725957 Myanmar 5252339 Nepal 2982204 Guinea 2019-11-01 2254407 Niger (the) 4058853 EMR Egypt NIDs 9 M-<6 Y 1.8e+07 Somalia 6 M-5 Y 2660000

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